Prostaglandin E1 and carbon dioxide reactivity during cerebral aneurysm surgery

Abe, Kazuo; Demizu, Akira; Kamada, Kiyoshi; Shimada, Yasuhiro; Sakaki, Toshisuke; Yoshiya, Ikuto

doi:10.1007/bf03008785

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…Several studies have assessed the time course of CVR in patients with ruptured intracranial aneurysms. CVR is often impaired in the early phase after aSAH [ 3 – 6 ], especially in patients with massive hemorrhage, poor neurological status at admission, and vasospasm [ 9 – 15 ]. There is a possible association between progressive impairment in CVR in the early phase after aSAH and subsequent development of delayed cerebral ischemia [ 9 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…In healthy persons, CVR is stable over time [ 2 ]. In the early phase after aneurysmal subarachnoid hemorrhage (aSAH), CVR is often impaired [ 3 – 8 ], especially in patients with massive hemorrhage, poor neurological status at admission, and vasospasm [ 9 – 15 ]. It has been suggested that transient reduction of CVR after aSAH may be associated with development of delayed cerebral ischemia and poor outcome [ 9 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Time Course of Cerebrovascular Reactivity in Patients Treated for Unruptured Intracranial Aneurysms: A One-Year Transcranial Doppler and Acetazolamide Follow-Up Study

Bøthun

Haaland

Logallo

et al. 2018

BioMed Research International

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Background Cerebrovascular reactivity (CVR) is often impaired in the early phase after aneurysmal subarachnoid hemorrhage. There is, however, little knowledge about the time course of CVR in patients treated for unruptured intracranial aneurysms (UIA). Methods CVR, assessed by transcranial Doppler and acetazolamide test, was examined within the first postoperative week after treatment for UIA and reexamined one year later. Results Of 37 patients initially assessed, 34 were reexamined after one year. Bilaterally, baseline and acetazolamide-induced blood flow velocities were higher in the postoperative week compared with one year later (p < 0.001). CVR on the ipsilateral side of treatment was lower in the initial examination compared with follow-up (58.9% versus 66.1%, p = 0.04). There was no difference in CVR over time on the contralateral side (63.4% versus 65.0%, p = 0.65). When mean values of right and left sides were considered there was no difference in CVR between exams. Larger aneurysm size was associated with increased change in CVR (p = 0.04), and treatment with clipping was associated with 13.8%-point increased change in CVR compared with coiling (p = 0.03). Conclusion Patients with UIA may have a temporary reduction in CVR on the ipsilateral side after aneurysm treatment. The change in CVR appears more pronounced for larger-sized aneurysms and in patients treated with clipping. We recommend that ipsilateral and contralateral CVR should be assessed separately, as mean values can conceal side-differences.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Time Course of Cerebrovascular Reactivity in Patients Treated for Unruptured Intracranial Aneurysms: A One-Year Transcranial Doppler and Acetazolamide Follow-Up Study

Bøthun

Haaland

Logallo

et al. 2018

BioMed Research International

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“…The overall methodological quality was satisfying. Results after excluding articles inconsistent with our surgery timing definition showed no significant difference for poor outcome, with early vs intermediate treatment (RR 0.86[0.68,1.09]), early vs late (RR 0.99[0.70,1.40]). Subgroup analysis based on age showed that early surgery could obtain more favorable outcomes for death rate, with non-early group as reference when age ≥50 years (RR 0.52[0.29,0.93]).…”

Section: Resultsmentioning

confidence: 91%

“…952 articles were found to be ineligible based on irrelevant titles and abstracts. After detailed evaluation of the remaining 57 articles, 1 RCT (34) and 33 cohort studies (1,(4)(5)(6)(9)(10)(11)(12)14,16,17,(20)(21)(22)(23)(24)(25)(26)28,30,31,33,(36)(37)(38)40,41,43,44,46,47,49,52) were included for reasons described in Figure 1.…”

Section: █ Resultsmentioning

confidence: 99%

Surgical timing for aneurysmal subarachnoid hemorrhage: a meta-analysis and systematic review

Zhao

Yi²

2015

Turkish Neurosurgery

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dent after surgery (19). Therefore, with the economic burdens of aSAH increasing every year, cost effectiveness and preventative strategies have become much more important.Before the 1970s, it was thought that cerebral edema and cerebral vascular dysregulation after acute aSAH, were associated with early surgery. In order to avoid the unfavorable █ INTRODUCTION A lthough intracranial aneurysmal subarachnoid hemorrhage (aSAH) accounts only for 3% to 4% of all strokes and 4.4% of deaths from stroke (18,50), aSAH is a significant health problem, which within 1 month has a mortality rate of nearly 50%, and many patients become care-depenAIm: Despite great advances in treatment of aneurysmal subarachnoid hemorrhage (aSAH), yet, a consensus as to the most optimal timing of surgery has not been reached. In order to identify the most suitable time of surgery for aSAH, the authors conducted a meta-analysis and systematic review. mATERIAl and mEThODS: PubMed and the Cochrane Library were searched for English-language studies published up to May 2015. Two independent reviewers screened abstracts, reviewed full-text articles and extracted data. Before conducting the metaanalysis, the studies were evaluated for publication bias and heterogeneity. Fixed and random effect models were used to estimate relative risks (RR) and the corresponding 95% confidence intervals (CIs). Subgroup analysis and sensitivity analysis were also performed. RESUlTS:One randomized controlled trial (RCT) and 33 observational studies of 16,793 participants were included in this paper. The overall methodological quality was satisfying. Results after excluding articles inconsistent with our surgery timing definition showed no significant difference for poor outcome, with early vs intermediate treatment (RR 0.86[0.68,1.09]), early vs late (RR 0.99[0.70,1.40]). Subgroup analysis based on age showed that early surgery could obtain more favorable outcomes for death rate, with non-early group as reference when age ≥50 years (RR 0.52[0.29,0.93]). When less than 50 years old, patients could benefit more from early intervention for poor outcome, with intermediate group as reference (RR 0.18[0.04,0.78 ]).CONClUSION: Despite the shortcomings of this study, timing of surgery for aSAH did not put a significant impact on overall surgical outcome. But subgroup analysis indicated a trend with more benefits for early treatment. Given the risks of re-bleeding and inpatient stay, early intervention should be performed as soon as possible. However, more randomized trials with long-term followup are necessary, especially in this era of endovascular coiling.

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“…I NTRAVENOUS prostaglandin E 1 (PGE 1 ) is reported to be safe and useful for controlled hypotension during surgery (1). Its main advantages include a rapid onset of action, a quick recovery from hypotension (2) due to a short elimination half‐life, lack of toxicity, maintenance of adequate perfusion to vital organs (1, 3), and maintenance of cerebral blood flow reactivity to carbon dioxide (4, 5) during hypotension. The elimination half‐lives of PGE 1 are reported to be 0.2 min (alpha phase) and 8.2 min (β phase) (6).…”

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confidence: 99%

Effect of intravenous prostaglandin E₁ on pial vessel diameters and intracranial pressure in rabbits

Miyabe¹,

Fukuda²,

Saito³

et al. 2001

Acta Anaesthesiol Scand

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Prostaglandin E1 and carbon dioxide reactivity during cerebral aneurysm surgery

Cited by 10 publications

References 25 publications

Time Course of Cerebrovascular Reactivity in Patients Treated for Unruptured Intracranial Aneurysms: A One-Year Transcranial Doppler and Acetazolamide Follow-Up Study

Time Course of Cerebrovascular Reactivity in Patients Treated for Unruptured Intracranial Aneurysms: A One-Year Transcranial Doppler and Acetazolamide Follow-Up Study

Surgical timing for aneurysmal subarachnoid hemorrhage: a meta-analysis and systematic review

Effect of intravenous prostaglandin E₁ on pial vessel diameters and intracranial pressure in rabbits

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Prostaglandin E1 and carbon dioxide reactivity during cerebral aneurysm surgery

Cited by 10 publications

References 25 publications

Time Course of Cerebrovascular Reactivity in Patients Treated for Unruptured Intracranial Aneurysms: A One-Year Transcranial Doppler and Acetazolamide Follow-Up Study

Time Course of Cerebrovascular Reactivity in Patients Treated for Unruptured Intracranial Aneurysms: A One-Year Transcranial Doppler and Acetazolamide Follow-Up Study

Surgical timing for aneurysmal subarachnoid hemorrhage: a meta-analysis and systematic review

Effect of intravenous prostaglandin E1 on pial vessel diameters and intracranial pressure in rabbits

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Effect of intravenous prostaglandin E₁ on pial vessel diameters and intracranial pressure in rabbits